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Ebola scare sparks discussion on quarantine, other policies to keep infectious diseases in check

by Kate Tormey ~ December 2014 ~ Stateline Midwest »
As the Ebola virus continues to affect tens of thousands of people halfway across the world in Africa, it is also spurring policy discussions in the United States about how governments can and should control the spread of serious infectious diseases.
The controversy has been fueled by the story of an American nurse who returned in October from an aid mission to Sierra Leone. When she arrived at Newark Airport, her outrage over New Jersey’s strict quarantine laws — and subsequent refusal to comply with her home state of Maine’s rules — set off a nationwide debate.
And it has caused citizens and policymakers alike to ask: When a dangerous disease is identified, who has the power to isolate and quarantine citizens? The answer is complex, but states have broad powers to keep people who are infected — or suspected to be — from having extensive contact with other people.
Public-health officials have two different powers regarding the issue. Isolation is used to ensure that people confirmed to be sick don’t spread the disease further.
But the more widely used — and perhaps more controversial — power is quarantine, which restricts the movements of people who were exposed to a contagious disease but are not confirmed to be ill. In essence, it’s a period of watching and waiting to see if a person gets sick. Laws must balance individuals’ rights with the need to protect the health of the general public.
On the national level, the federal government has the authority to take steps to prevent communicable diseases from entering the country — and spreading between states. The U.S. Centers for Disease Control and Prevention routinely monitor people arriving at land borders and by ship, looking for symptoms of such diseases. The CDC can legally detain and examine people at borders or traveling between states.
However, this authority can be used only for diseases for which it is specifically approved by presidential executive order. The current list includes nine diseases, including viral hemorrhagic fevers (such as Ebola), cholera and smallpox. The last major federal quarantine was during the influenza pandemic of 1918 and 1919.
But within states, the responsibility to protect the public from infectious disease lies with state policymakers and health officials. State laws vary regarding isolation and quarantine, with some authorizing officials to handle most suspected cases of disease and others transferring that power to local officials.
In Illinois, for example, the state has “supreme authority in matters of quarantine,” but laws also allow local officials to take action to keep disease from spreading. However, in Kansas, Ohio and South Dakota, local officials have primary responsibility for supervising potential outbreaks; state agencies can step in if local governments are deemed to neglect their duty.
Indiana gives more power to its department of health, which can enforce its rules in local jurisdictions during emergencies. But in Iowa, Michigan and Wisconsin, either the state public-health department or local officials can impose quarantine and isolation. Iowa’s law states that quarantine “shall rarely be imposed.”
Other related powers are granted to officials throughout the Midwest. In Kansas and Michigan, for example, local health officers can prohibit public gatherings in order to prevent the spread of a disease.
Minnesota’s law allows the state health commissioner to inspect modes of transportation crossing state borders. Agents can isolate or quarantine passengers, with their luggage, as long as deemed necessary. (South Dakota’s law includes a similar provision.) Minnesota physicians, too, must report to the state the name of anyone who refuses to comply with isolation procedures. The state can seek an injunction if the person is a risk to public health.


Brief written by Kate Tormey, staff liaison to the Midwestern Legislative Conference Health and Human Services Committee. The committee’s co-chairs are Iowa Rep. Joel Fry and Minnesota Sen. Kathy Sheran.